.jpeg.jpg "Jonathan Pelletier, MD photo")
Jonathan Pelletier, MD
Clinical Instructor
Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center
Pittsburgh, Pennsylvania
Disclosure information not submitted.
.jpg "Jaskaran Rakkar, MD photo")
Jaskaran Rakkar, MD
UPMC Children's Hospital of Pittsburgh
Pittsburgh, Pennsylvania
Disclosure information not submitted.
Dennis Simon, MD
Assistant Professor of Critical Care Medicine and Pediatrics
UPMC Children's Hospital of Pittsburgh, United States
Disclosure information not submitted.
Alicia Au, MD
Assistant Professor, Critical Care Medicine. Associate Medical Director, PICU
Children's Hospital of Pittsburgh of UPMC, United States
Disclosure information not submitted.
Dana Fuhrman, DO, MS
Children's Hospital of Pittsburgh of UPMC
Pittsburgh, Pennsylvania
Disclosure information not submitted.
Robert Clark, MD, FCCM
Professor of Critical Care Medicine and Pediatrics
Childrens Hospital of Pittsburgh of UPMC, United States
Disclosure information not submitted.
.jpg "Patrick Kochanek, MD, MCCM photo")
Patrick Kochanek, MD, MCCM
Director, Safar Center for Resuscitation Research
UPMC Presbyterian
Pittsburgh, Pennsylvania
Disclosure information not submitted.
Christopher Horvat, MD, MHA
Children's Hospital of Pittsburgh of UPMC
Pittsburgh, Pennsylvania
Disclosure information not submitted.
Title: Association Between Zip-Code Level Income and Pediatric TBI Mortality in the United States
Introduction:
There are important regional differences in pediatric traumatic brain injury (TBI) mortality across the United States. The mechanisms underlying these differences are unclear. We conducted a database analysis to elucidate factors associated with pediatric TBI mortality.
Methods:
We performed a retrospective cross-sectional analysis of hospitals contributing to the Pediatric Health Information System database since 2010. We included all initial inpatient hospital encounters for children less than 18 years old with a primary diagnosis of TBI (based on International Classification of Diseases identified by the US Military Health System) between 2010-2019. Hospitals were grouped according to their US Census Division. Encounters were mapped to patient-level zip-code 2010 median family income. Cohort demographics were described with summary statistics. Multivariable logistic regression was used to analyze regional differences in pediatric TBI mortality after adjusting for sociodemographic factors and injury type.
Results:
There were 50,872 encounters among 50,301 patients across 38 hospitals. There were 5,489 admissions in 2010 compared to 4,933 in 2019, p = 0.039 for trend. Mortality in pediatric TBI ranged from 4.1% in the East South Central region to 1.2% in the Pacific region, p < 0.001. Hospital-level mortality in pediatric TBI ranged from 0.6% - 6.1%, p < 0.001. Median (IQR) 2010 family income was $40,643 ($32,496 - $52,917). Lower median family income was associated with ballistic TBI injuries and mortality. Every $10,000 of income was associated with a 0.33% decrease in ballistic TBI, and a 0.13% decrease in TBI mortality. A multivariable regression model had excellent performance in discriminating mortality, c-statistic (95% CI) 0.957 (0.955-0.959). In regression, the East South Central region was associated with TBI mortality, OR (95% CI) 1.59 (1.21 - 2.09) compared to the pacific region. Ballistic TBI was associated with mortality, OR (95% CI) 3.36 (2.58 - 4.38). Regional variation in ballistic TBI was correlated with regional TBI mortality adjusted r-squared 0.588, p = 0.01).
Conclusions:
Pediatric TBI displays regional heterogeneity in mortality after adjustment for injury type and sociodemographic factors. Lower family income is associated with increased ballistic TBI and TBI mortality.